Periperative Period Flashcards
How should a diabetic patient on insulin be managed peri-operatively?
- try to put 1st on the list to minimise the fasting period
- continue long acting (basal) insulin but omit rapid/short acting insulin (bolus)
- if not eating and drinking post-op, put on sliding scale 2 hours before surgery and give continuous IV fluids containing glucose
- finger prick glucose every 2 hours
What insulin is prescribe on an insulin sliding scale?
50 units of short acting insulin e.g. Actrapid, in 50ml of 0.9% saline
Rate of infusion depends on the capillary blood glucose
Can a patient on warfarin continue their mediation prior to major surgery?
No
Stop 2-5 days before surgery
Can convert to herparin and stop 6 hours before surgery
When re-warfarinising, continue heparin until INR is therapeutic
How can heparin be reversed?
Protamine
What is the most likely causative organism of a surgical site infection?
Staph aureus
What are some risk factors for a surgical site infection?
Preoperative shaving Poor wound closure Inadequate instrument sterilisation Site of procedure eg at skin create Poor nutrition Diabetes or renal failure Smoking Immunosuppression Length of operation and post operative hospital stay
How should a surgical site infection be managed?
Open the infected wound
Drain pus
Empirical Abx
Monitor for sepsis
What is atelectasis?
Partial collapse of the small airways, presents in s9me degree in the majority of post op patients
What tool can be used to screen for malnutrition?
MUST score
What is post-op ileus and how would it present?
Deceleration in intestinal motility following surgery
Classed as a functional obstruction
Presents with bloating and distension, failure to pass gas or faeces, nausea and vomiting
A red blood cell transfusion is recommended for patients with a Hb of less than what?
70
And aim for 70 to 90 after transfusion
Are most of the population Rheus D + or -?
85% are + (do express Rheus D surface antigens)
15% are - (RhD antigens absent)
Why must RhD specific blood be given to women especially?
To avoid haemolytic disease of the newborn
So in an emergency it would be possible to give a RhD- male so RhD+ blood
What blood type is classed as the universal donor?
O-ve
(No AB and no Rheus antigens on the donor RBC surface membrane so even if A/ B/ Rheus antibodies where INR he circulation, they are unlikely to eject this blood as there are no ABO or Rh antigens to attack)
Which blood type is classed as the universal acceptor?
AB+ve
(Recipient demos not have A, B or Rheus antibodies in their circulation so cannot moving an immune response to the donor blood)
What is a group and save?
Blood test that determine a patients blood group (ABO and RhD) and screens for any atypical antibodies
Take around 40 minutes and no blood is issued
Recommended to do when blood loss is not anticipated, but blood may be required if there is a greater blood loss than expected
What is a cross match blood test?
Physical mixing of the patients blood with the donor blood to see if an immune reaction takes place so do not blood can be issued and transfused to the patient
Takes additional 40 mins to G&S
Done if blood loss if anticipated
What is ASA grading?
A grade given to patients after their pre op assessment to determine their anaesthetic risk, it correlates with the risk of post operative complications and mortality
What is a typical patient with ASA grade 1?
Normal healthy non smoking patient who drinks minimal- no alcohol
An otherwise healthy patient with a BMI of 32 is classed as which ASA grade?
Grade 2
What are typical grade 2 ASA patients?
Mild systemic disease without functional limitation e.g. current smoker, pregnancy, obesity 30-40, social drinker, well controlled DM/ HTN
What is a typical px with an ASA grade of 3?
Severe systemic disease with functional limitation e.g. poorly controlled DM/ HTN, COPD, morbid obesity >40, alcohol abuse, pacemaker, active hepatitis
What is ASA grade 4?
A patient with sever systemic illness that is a constant threat to life
E.g. recent MI/ CVA <3/12, severe HF, sepsis
What is ASA grade 5?
Moribund px who is not suspected to survive w/o operative eg ruptured AAA, ischaemic bowel, major trauma, intracranial bleed
What is ASA grade 6?
Brain dead px whose organs are being harvested for donation
What is profolol?
An IV agent typically used to induce anaesthesia before switching to a maintenance agent (typically inhalational agent eg desflurane)
What is the action of odansetron?
Antiemetic, 5HT antagonist
